It’s been a while since we’ve done a Covid/bioethics podcast (see prior ethics podcasts here, here, here, and here).  But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations.   This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NIH guidance for allocation of Paxlovid during conditions of scarcity.  They argue that the current guidelines, which prioritize immunocompromised people and unvaccinated older people on the same level, should be re-done to prioritize the immunocompromised first, and additionally move up older vaccinated individuals or vaccinated persons with comorbidities.  The basis of their argument is the ethical notion of “reciprocity” - people who are vaccinated have done something to protect the public health, and we owe them something for taking that action.  Eric and I attempt to poke holes in their arguments, resulting in a spirited discussion. To be sure, Paxlovid is no longer as scarce as it was a few months back.  But the argument is important because, as we’ve seen, new treatments are almost always scarce at the start.  Evusheld is the latest case in point.  Sometimes, you can’t always get what you want… -@AlexSmithMD